Molecular Profiling of Human Papillomavirus (HPV) Genotypes in Iranian Women with Atypical Squamous Cells of Undetermined Significance (ASCUS) Cytology: Predominance of High-Risk Types Linked to Cervical Cancer Risk

Abstract

Background: Human papillomavirus (HPV) is a common sexually transmitted infection and a major cause of cervical cancer, which is a leading cause of cancer-related death among women worldwide. Objectives: This study aimed to molecularly profile HPV genotypes in Iranian women with atypical squamous cells of undetermined significance (ASCUS) on cytology using real-time polymerase chain reaction (PCR) to improve viral detection, genotype characterization, risk stratification, and clinical management. Methods: A total of 150 women with ASCUS cytology were enrolled at Shahid Beheshti Hospital, Tehran, from March to November 2023. Following ethical approval and informed consent, combined vaginal-cervical samples were collected using sterile swabs, processed within 4 hours, and DNA was extracted using the phenol-chloroform method. HPV genotyping for 16 high-risk types was performed using SYBR Green real-time PCR with high-resolution melting (HRM) analysis and confirmed by Sanger sequencing. Qualitative results were analyzed using appropriate statistical methods. Results: Among women aged 21 to 63 years, 28.67% had low-risk HPV and 71.33% had high-risk HPV. The predominant genotypes were low-risk HPV 11 (20%) and high-risk HPV 16 (12.67%). Women with high-risk genotypes had significantly higher rates of vaginal discharge (39.25%) and burning/itching (46.73%) than those with low-risk genotypes (P < 0.001 and P = 0.001, respectively). Specific genotypes included HPV 16 (12.66%) and HPV 18 (9.66%). Conclusions: Iranian women with ASCUS had a high prevalence of high-risk HPV genotypes, particularly HPV 16 and 18, which were associated with symptoms and an increased risk of cervical cancer. These findings underscore the need for effective diagnostic and preventive measures in Iran, particularly those targeting HPV 16.